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Billing code

A994A — Weekday evening office special visit premium, first patient

Weekday evening office first-patient premium

Bill A994 for the first patient seen at the office on a non-elective special visit, Monday to Friday, 17:00 to 24:00.

Watch for: Bill it with an A-prefix assessment and chart the visit time; not payable when the office is scheduled to be open.

Code

A994A

Description

Weekday evening office special visit premium, first patient

FHO+ basket

Covered by the FHO+ base rate payment for enrolled patients, and shadow billed at 30% (50% for Schedule 2B procedures).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

Special visit premium for the first patient seen in the office on a non-elective call, Monday to Friday evenings (17:00 to 24:00).

What it covers

A994 is the 'first person seen' premium in Special Visit Premium Table VIII, Physician Office, for evenings 17:00 to 24:00, Monday to Friday (GP76).

It pays for going to the office outside regular hours to see a patient for a non-elective problem. The first person seen premium applies when the service starts in the evening on a weekday (GP66).

Billing rules

• Maximum one per time period (GP76).
• A special visit is one initiated by the patient, or someone on their behalf, for a non-elective service (GP65).
• Not payable for patients who come in without an appointment while the physician is there, or who are seen just before, during or just after regular office hours, even if those hours are at night or on a weekend (GP65).
• Not payable when the office is scheduled to be open for patients at that time (GP65).
• Bill the A-prefix assessment from the General Listings with the premium (GP69).
• The time of the visit must be in the medical record (GP69).
• Not payable with A888 (GP3).

Often billed with

• The A-prefix assessment for the patient, such as A007 (GP69).
• A962 travel premium (maximum one per time period) when the physician travels to the office for the call (GP76).

Common rejections

• ADF: OHIP's description is 'required related procedure missing, invalid or paid at zero'. A special visit premium is only paid with an A-prefix assessment on the same claim (GP69), so check that the assessment is there and payable.
• VH8: The date of birth doesn't match OHIP's record for the health number. Correct it and resubmit.
• EH2: The health card version code doesn't match the Ministry's record. Get the current version code and resubmit.

Related codes: A962, A990, A998, A996, A007

Source: Schedule of Benefits (July 1, 2026), General Preamble, Special Visit Premiums, pages GP65 to GP69 and Table VIII on GP76

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